Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Friday, February 26, 2016

I'm obviously naive, because it had not occurred to me that a corrupt, vulgar, pathologically lying bully would endorse Donald Trump for president, but that's what Chris Christie just did.

He would not have done this if he wasn't damn sure orange marmot-head was going to be the nominee. If there is any other outcome, Christie will be political compost. But the endorsement will be a self-fulfilling prophecy, quite possibly opening the floodgates.

After the spectacle of a "debate" last night consisting incoherent yelling, with white supremacists mobilizing to back the Trump campaign, it's obvious what this is all about. It isn't about health care, or taxes, or foreign policy, or abortion, or same sex marriage, or infrastructure, or climate change and environment, or public health, or education, or any of the myriad critical issues facing the nation and humanity.

Indeed. There have been a few instances of students murdering professors over grades and theses. James Holmes, the Aurora Colorado theater shooter, was a graduate student when he had his psychotic break, and that's the typical age for it. Young men in Texas include a whole lot of politically radical gun and violence fetishists who aren't having any truck with evolution, cosmology, climate change, or most of what I teach in public health for that matter.

So you could argue that it's salutary, even essential, to expose the rotten heart of American conservatism. He's opening up the canker and exposing the pus to the sunlight. And we all expect that in the general election, he'd be utterly wiped out along with the Republican Senate and even a good chunk of the House. Abrcadabra, Republican party destroyed, Hillary appoints Barack Obama to the Supreme Court (highly doubtful but wouldn't that frost their pumpkin?), and we get massive infrastructure spending, a carbon tax, immigration reform, and a multilateral foreign policy based on humanitarian objectives.

Or, the Trump candidacy legitimizes revolting rhetoric, extremism, and lunatic conspiracy theories. The world comes to view the United States with contempt and fear. (Maybe surprising they don't already.)

And then there's this. Could he possibly be elected? In a Clinton (or even more so Sanders) vs. Trump election, there's only one place the Koch brothers' billions could go. And the corporate media will be scrupulously fair and balanced. So who really knows? I wouldn't have thought the present situation was possible.

Wednesday, February 17, 2016

Scalia did not create and champion an important theory of constitutional interpretation, or really any theory at all. He just used whatever sophistry he could come up with to justify the conclusions he wanted to reach.

Those conclusions were to favor the powerful over the powerless, the oppressor over the oppressed. He was a raging bigot who actively promoted discrimination. He was a sadistic psychopathic who reveled in the execution of innocent people.

He was a vile and repulsive person. His death is the best news this country has had for quite a while. There, I said it.

Update: In case you don't think I'm qualified to say that Scalia did not, in fact apply any consistent theory of constitutional interpretation, but did whatever it took to reach the conclusion that favored his political allies, take it from Judge Posner, who is a real conservative.

Actually they seem to fall a bit short in their understanding of what public health means. For example, they say "Public health is not alone, sharing funding and infrastructure deficiencies with transportation, education and even public safety." In fact, all of these are part of public health. Education probably the single most powerful contributor to population health, particularly education of women and girls. Mass transit, cleaner and safer motor vehicles, fire and crime prevention -- these are all public health.

The problem in the U.S. right now is that public health is all about social justice, and fixing the problems that the mythical "free market" cannot. Therefore it is unpopular with the plutocrats who run things, who would have to pay taxes to make the planet better for the rest of us.

That's why the UN's new sustainable development goals, which were formally promulgated at the beginning of this year, seem unrealistic. If the wealthiest country on earth isn't interested in investing, it won't happen. The goals include ending poverty, ending hunger, quality education for all, gender equality, affordable clean energy, climate action -- you know, all that commie stuff. Unfortunately, we have an entire major political party, that controls most of the levers of power, that doesn't want any of that to happen. So let's tell it like it is.

Friday, February 12, 2016

Yes, it so happens to be his birthday, following the announcement yesterday of yet one more (kind of unnecessary) vindication of general relativity. It's worth noting here that it was general relativity, and the subsequent discovery of the expanding cosmos, that led straight to the modern understanding of cosmology and the horribly named "big bang" theory. I prefer to call it the Initial Singularity, or IS theory, because there was no bang.

Anyway, the have a deep philosophical connection, not in a positive sense -- they don't need each other to be true -- but in a negative sense, which is only important to humans right now. Between them, they dispose of God. They don't exactly make God impossible (especially since the concept is not consistently defined) but they make he/she/it completely unnecessary.

The trouble is, the more we learn about the universe the more pointless it seems, from our point of view. Which indeed it is. It isn't about us at all, we just happen to find ourselves here. I'm not sure why that's so difficult for so many people to accept. It doesn't bother me at all, we still are what we are and what is meaningful to us still matters -- but only to us. That's good news! We don't have to worry about how a merciful God could give us earthquakes and evildoers, or what we're supposed to put on the altar. We can go about explaining earthquakes and evildoers without any bother about that nonsense. And we don't have to ask "Why me?" when something bad happens to us. No particular reason other than the reasons you can observe.

The physicists who made this observation are saying it's a very big deal. Welllll . .. .kinda. It doesn't change anything at all about our understanding of the universe, it just confirms what has been understood for (coincidentally) just about 100 years before the observation, when Einstein published the theory of general relativity. In the years since, it has been confirmed by every test, including one that indirectly confirmed the existence of gravitational waves. Einstein himself didn't even think they would ever be detected because they are too subtle. So in that sense it's not a discovery at all. It is for sure an astonishing feat of technology. And it should lead to future detection of cataclysmic events, including some of much smaller magnitude that occur closer by.

But the real implications are philosophical. Again, nothing that many people -- but not most -- don't already understand. The scale of the universe is completely beyond the intuitive grasp of humans. This event happened, according to counting logarithms on my fingers, on the order of 10^20 kilometers away. According to the investigators, each of the black holes weighed about 30 times the mass of the sun; the event momentarily generated more energy than the entire light output of the universe, an impossibly tiny fraction of which humans just detected. You would not have wanted to be up close and personal. That tiny fraction represented a displacement smaller than the charge diameter of a single proton.

The very weird thing is that it only took 3 pounds of mush inside the heads of some of those talking apes to figure out how to look for these waves, and to find them. We pack about 86 billion neurons into that mush, which is all it takes to operate the body, eat fuck and fart, and discover a universe in which we are absolutely nothing. It's really no wonder that lots of people just don't want to believe it.

Wednesday, February 10, 2016

One of the many spiritual costs of spending a lot of time behind the wheel is having to read the bumper stickers on the battered vehicles of my struggling neighbors. Yesterday's soul-rotting annoyance was

Keep Working. Millions of welfare recipients are depending on you.

It was a rusty truck belonging to a tradesman of some kind. Then there was the National Pubic Radio interview with a couple of enthusiastic Trumpistas in New Hampshire who said that they were tired of illegal immigrants getting free cell phones and free health care. Of course NPR didn't bother to point out that illegal immigrants get absolutely no government benefits whatsoever. As always, they just let the falsehood sit there. (As Cokie articulates the policy, it doesn't matter if it's true, it's out there.)

As for the millions of welfare recipients, basically there aren't any, at last as my guy with the bumper sticker understands the concept. From Center for Budget and Policy Priorities more than 90% of government benefits (not counting tax breaks and subsidies for the rich, obviously) go to people who are elderly, disabled, or live in working households where the Walmart wages won't pay for the groceries. Almost all the rest goes to unemployment benefits, survivor benefits (you know, widows and orphans), and medical care (as opposed to paying for it some other way, as we have always done rather than let people expire in the hospital parking lot). In other words, the bumper sticker guy's mother, and himself if he's out of work (which he probably has been).

But Republicans get away with making people think there's a super secret kind of welfare that all the dark people are getting that they don't have access to. And the corporate media aren't going to set them straight on it because of Cokie's rule. That's where things stand.

Monday, February 08, 2016

Anna Marie Barry-Jester at 538 tries to tell us what went wrong in Flint. She doesn't get very far, it seems to me. Yes, she chronicles how responsible officials ignored and belittled citizen complaints, and cooked the books on testing the water. But she doesn't explain why they did this, and she doesn't go more than two links up the chain, either, pretty much sticking to the actions of flunkies.

I'm not going to speculate about where the true responsibility lies here -- apparently the FBI is on the case and maybe they'll make some headway through the zone of plausible deniability. But the fact is, this is a crime so vast, and so horrific, it's difficult for the mind to encompass. People get 20 years for armed robbery and life in prison or the needle for murdering one person. But I will be very surprised if anybody even pays a fine for poisoning an entire city, damaging the brains of thousands of children, diminishing their prospects, and shortening their lives.

Wednesday, February 03, 2016

I believe I have commented here previously about CRISPR, which is a recently developed method for precise editing of genes borrowed from prokaryotic cells. (If you aren't up to speed on the technical background, that's not really the point of this post. But I will be kind enough to say that prokaryotes are bacteria and archaea, single celled organisms without a nucleus. We are eukaryotes.) It enables scientists to make specific changes at exact sites in a gene, not without some rate of error although they are continually improving the technique.

You don't have to think very hard to see where this could lead. Although we don't yet know enough about the genetic basis of human traits such as intelligence or ability to play basketball, while we're figuring that out we could correct genetic diseases caused by single mutations. If you edit genes in a zygote, the changes will end up in all the cells of the resulting embryo, and so be heritable by the genetically enhanced persons offspring. Yep, supermanperson.

As you might imagine, I don't have a problem with this. These are surplus embryos from in vitro fertilization, of which thousands are routinely discarded anyway. The anti-abortionists for the most part don't seem to have a problem with that, oddly, even though according to their ideology these are morally indistinguishable from babies. But I expect this will get their attention, not because it's any different by any rationally defensible criteria but because it creates an intuitive offense to moral sensibility, i.e. the embryos are a means to an end.

Since they aren't people, that shouldn't matter. But if you think they are, it must, no?

What will probably trouble many more people is not these particular experiments, but where we might end up in the future. If it's possible to create genetically enhanced humans, it's hard to see how it will never happen.